In examining the insidious marketing strategies Big Pharma uses to put profits ahead of people’s health, I have often noted the lack of a constituency for patients with the devastating disease on which I focus most, chronic schizophrenia. This article focuses on the challenges the drug companies face in marketing newly-developed (and monumentally expensive) antipsychotic drugs for this population.
Since the mid-1990’s, a group of drug companies, led by Johnson & Johnson, has campaigned to convince state officials that a new generation of drugs – with names like Risperdal, Zyprexa and Seroquel – is superior to older and much cheaper antipsychotics like Haldol. The campaign has led a dozen states to adopt guidelines for treating schizophrenia that make it hard for doctors to prescribe anything but the new drugs. That, in turn, has helped transform the new medicines into blockbusters.
Ten drug companies chipped in to help underwrite the initial effort by Texas state officials to develop the guidelines. Then, to spread the word, Johnson & Johnson, Pfizer and possibly other companies paid for meetings around the country at which officials from various states were urged to follow the lead of Texas, according to documents and interviews that are part of a lawsuit and an investigation in Pennsylvania. —New York Times
The marketing pressure the manufacturers exerted allegedly includes payoffs and other illegal or marginally legal practices. In comparative studies, these drugs have comparable efficacy to the older antipsychotics. Early claims that they are more effective have gone by the boards. Pitching them to prescribers has largely relied on claims that they are better tolerated and safer than the older drugs in terms of side effects. While this is true (patients on them develop the devastating neurological effects of the older drugs far less often), they turn out to have important metabolic complications (effects on glucose and lipid metabolism, weight gain and in some cases cardiac risks). Psychiatrists like myself and other physicians are the objects of a relentless full court press from the manufacturers to diffuse prescribers’ concerns about such liabilities to their patients. Suffice it to say that physicians should be collectively ashamed of how they have handed control over what they learn about prescribing new medications to the pharmaceutical companies that profit from those drugs.
